Jessica & Conan
Member Since 2016
Previous posts:
- http://www.felinediabetes.com/FDMB/threads/2018-04-11-conan-tresiba-insulin-degludec-update.194017/
- http://www.felinediabetes.com/FDMB/threads/2018-04-07-conans-first-day-on-insulin-degludec-tresiba.193815/#post-2172939
As I mentioned at the end of one of the previous threads, entirely independent of his insulin/diabetes, Conan hasn't been doing very well. In the last 4-5 days his appetite has been greatly reduced and he's been extremely lethargic. We went to the vet today, and an ultrasound revealed that despite the fact that he's eaten very little, his stomach is full, suggesting his intestines aren't moving. It's not clear why, as there are no physical blockages. He has IBD, though, and his digestive system doesn't always work properly. It seems very plausible that the food in his stomach, increased stomach acid, and sluggishness of his system are causing him to feel generally ill, bloated, and certainly not hungry. We are trying metoclopramide injections (for gastric/intestinal motility) for the next few days to see if that helps.
But neither the vet nor I feels that this is related to his insulin.
With regard to the insulin, I increased him to 2U last Friday. My BG testing during the days hasn't always been consistent since then. However, I've been able to do enough testing to feel somewhat confident that this dose seems to be getting his numbers to a good place for much of the day, and keeping it there relatively evenly. The thing about Tresiba that is different from Lantus and Levemir - for Conan - is that there seems to be no jumping around, no spikes or dips and peaks. The insulin starts to take effect, his numbers drop, they stay dropped, then they gradually start to rise until the insulin (I believe) wears off. But even when he went fairly low, into the greens, for the first time, there was no real bounce, not like he experienced on the Levemir certainly, or on the Lantus when we used it for the first 6 months after his diagnosis.
Also, it seems that it lasts for a good 10 hours or so, though it's hard to tell as 1) we haven't been on 2U long enough; and 2) I haven't been able to test consistently enough throughout the day.
HOWEVER - it also seems clearer to me now that the insulin *is* in fact only lasting roughly 12 hours. After that his numbers go up, and they stay up throughout the next 12 hours. They don't "bounce" up to the high reds or blacks, and that's what was confusing me at first - they just politely go back to what I presume is his "normal" high level, generally ranging throughout the 300s (on a human meter; it would be higher than that in the lab). But I feel fairly certain that the insulin is having no or minimal effect during these hours, because even though his BG values for the 12 or so hours post-shot have gone down noticeably and unmistakably each time I've increased his dose, the overnight values in the +12-+24 range have not changed at all. They are the same at 2U as they were at 1.5U.
It's true that he's slightly lower at AMPS than he is at, say +15 - but I am thinking now that this is just his natural cycle.
So....once he's had a bit more time at 2U for me to get more readings, and for me to be sure that he's "settled out" at this dose and isn't continuing to go any lower (it definitely takes a few days on this insulin for that to happen!), and also once he, hopefully, improves his eating and his medication takes effect, I am going to take the plunge and move to BID dosing - at this dose. I am going to have to do that at a time when I can monitor him closely, since it could possibly result in some low levels. My hope is that there will be a little overlap so he will have no period in which the insulin "wears off" (as it is doing now in the +10-+12 range; also it seems to take until about +2 before it starts to bring his BG down again).
In humans the duration of action is up to 40 hours, and yet most dose every 24 hours, and studies indicate that it doesn't really matter if it's exactly 24 hours, or instead 20 or 30. I'm hoping that will be the same for cats, so some overlap won't result in really low numbers, but instead it will all smooth out. And also - maybe it won't be as critical that the shots be *exactly* 12 hours apart, which is sometimes an issue for me.
But as I said, I'm going to still wait a few more days to try that.
So far I have to say though that I'm very pleased with the Tresiba! We aren't yet anywhere near working out a final dosage for Conan, but the curve appears to be by far the best of the insulins he's tried - the most smooth and consistent, and it keeps him controlled the most evenly for the longest time. So far. We've still got a ways to go though!
- http://www.felinediabetes.com/FDMB/threads/2018-04-11-conan-tresiba-insulin-degludec-update.194017/
- http://www.felinediabetes.com/FDMB/threads/2018-04-07-conans-first-day-on-insulin-degludec-tresiba.193815/#post-2172939
As I mentioned at the end of one of the previous threads, entirely independent of his insulin/diabetes, Conan hasn't been doing very well. In the last 4-5 days his appetite has been greatly reduced and he's been extremely lethargic. We went to the vet today, and an ultrasound revealed that despite the fact that he's eaten very little, his stomach is full, suggesting his intestines aren't moving. It's not clear why, as there are no physical blockages. He has IBD, though, and his digestive system doesn't always work properly. It seems very plausible that the food in his stomach, increased stomach acid, and sluggishness of his system are causing him to feel generally ill, bloated, and certainly not hungry. We are trying metoclopramide injections (for gastric/intestinal motility) for the next few days to see if that helps.
But neither the vet nor I feels that this is related to his insulin.
With regard to the insulin, I increased him to 2U last Friday. My BG testing during the days hasn't always been consistent since then. However, I've been able to do enough testing to feel somewhat confident that this dose seems to be getting his numbers to a good place for much of the day, and keeping it there relatively evenly. The thing about Tresiba that is different from Lantus and Levemir - for Conan - is that there seems to be no jumping around, no spikes or dips and peaks. The insulin starts to take effect, his numbers drop, they stay dropped, then they gradually start to rise until the insulin (I believe) wears off. But even when he went fairly low, into the greens, for the first time, there was no real bounce, not like he experienced on the Levemir certainly, or on the Lantus when we used it for the first 6 months after his diagnosis.
Also, it seems that it lasts for a good 10 hours or so, though it's hard to tell as 1) we haven't been on 2U long enough; and 2) I haven't been able to test consistently enough throughout the day.
HOWEVER - it also seems clearer to me now that the insulin *is* in fact only lasting roughly 12 hours. After that his numbers go up, and they stay up throughout the next 12 hours. They don't "bounce" up to the high reds or blacks, and that's what was confusing me at first - they just politely go back to what I presume is his "normal" high level, generally ranging throughout the 300s (on a human meter; it would be higher than that in the lab). But I feel fairly certain that the insulin is having no or minimal effect during these hours, because even though his BG values for the 12 or so hours post-shot have gone down noticeably and unmistakably each time I've increased his dose, the overnight values in the +12-+24 range have not changed at all. They are the same at 2U as they were at 1.5U.
It's true that he's slightly lower at AMPS than he is at, say +15 - but I am thinking now that this is just his natural cycle.
So....once he's had a bit more time at 2U for me to get more readings, and for me to be sure that he's "settled out" at this dose and isn't continuing to go any lower (it definitely takes a few days on this insulin for that to happen!), and also once he, hopefully, improves his eating and his medication takes effect, I am going to take the plunge and move to BID dosing - at this dose. I am going to have to do that at a time when I can monitor him closely, since it could possibly result in some low levels. My hope is that there will be a little overlap so he will have no period in which the insulin "wears off" (as it is doing now in the +10-+12 range; also it seems to take until about +2 before it starts to bring his BG down again).
In humans the duration of action is up to 40 hours, and yet most dose every 24 hours, and studies indicate that it doesn't really matter if it's exactly 24 hours, or instead 20 or 30. I'm hoping that will be the same for cats, so some overlap won't result in really low numbers, but instead it will all smooth out. And also - maybe it won't be as critical that the shots be *exactly* 12 hours apart, which is sometimes an issue for me.
But as I said, I'm going to still wait a few more days to try that.
So far I have to say though that I'm very pleased with the Tresiba! We aren't yet anywhere near working out a final dosage for Conan, but the curve appears to be by far the best of the insulins he's tried - the most smooth and consistent, and it keeps him controlled the most evenly for the longest time. So far. We've still got a ways to go though!
I hope Conan feels better soon as all that he has going on is bound to mess with things and not show the clearest picture of what is happening (case in point, Asia’s SS recently, UTI). Healing and motility vines for pioneer Conan. 